My COBRA health insurance expired Nov. 30, which led me to the ACA. I am one of roughly 40 percent of Americans not covered by Employer Sponsored Insurance, a group that includes large company and public employer-paid health insurance plans. Those with the attitude of “I got mine so you get yours” do not understand the financial havoc the ESI model imposes on the unemployed, self-employed, or small company employed. It comes as no surprise that Big Health has spent billions of dollars since Word War II to build and reinforce this model through bought-and-paid lobbyists and career politicians. Big Health still has way too much skin in the game to make the ACA work.

Under the ACA my steep COBRA premiums are steeper, my deductibles higher, and my total out of pocket … well, you get the idea. But, I am grateful knowing that I cannot be denied as I have been twice before. I will not become one of pre-ACA statistics of tens of thousands hard-working, taxpaying Americans who were forced into foreclosure or died as a result of no health insurance when crisis knocked. But, I am still angry that I am stoking the insatiable greed of Big Health and its symbiotic parasites (i.e., lobbyists and career politicians). A simple analysis of my ACA costs produces a scenario where I could spend $23,000 without receiving a penny in benefits!

What’s wrong with this “system” that many pay disproportionate out-of-pocket costs while others with ESI enjoy subsidized insurance paid by our tax dollars or corporate profits that become corporate and personal tax deductions. To add insult to injury, big box retailers and hourly wage industries dump their part-time indentured employees into the ACA exchanges by restricting their hours, thereby, disqualifying them from company paid benefits like ESI. Presto! The ACA is now a Big Health pig in cheap lipstick.

The Commonwealth Fund’s June 2014 national health system scorecard issued some disturbing news about the U.S. health care system. Granted, we have inched forward since the implementation of the ACA (20 million-plus more insured), but the U.S. health care system still ranks as the most expensive in the world but is dead last or near last on ease of access, efficiency, equity and healthy lives. Overall we ranked last among 11 developed nations. A 2000 World Health Organization ranking of 191 member states ranked the U.S. 38th behind Costa Rica and the Dominica. It comes as no surprise that the most notable difference from the other countries is the absence of universal health insurance coverage. And yet these countries systems cost less and give much more back. What’s wrong with this picture? It’s time for some real reform and big savings.

We need a centralized health care system to maintain better cost control and resources, particularly for readily available preventive and general care. We need federally sponsored medical educational system that obligates newly minted doctors to “pay back” their education by serving their early careers where needed like Tumbleweed, USA. Likewise, we need to incentivize more doctors into general practice instead of flooding high cost-of-living areas with more proctologists than needed. We need radical but reasonable tort reform to protect both doctors and patients while driving legal costs down. We need to rid our “system” of the redundant fee-for-service payment model that drives up costs due to unnecessary treatments. Finally, we as health consumers need to not expect Cadillac service when a longer wait or general care will suffice.

We also need to change attitudes toward health care for all. The lower and middle classes represent our largest consumer base. They need to be healthy and productive with more money in their pockets to keep our economy vibrant. They also make the most sacrifices when it comes to military service. It goes without saying, we also need to radically reform our tax code to rid ourselves of the thousands of loop holes that only benefit the super-rich and big corporate interests. This would align tax revenues with more important cultural values like a healthier America, financially and medically. Yes, I am grateful for the unaffordable Affordable Care Act … until the next new pig in lipstick is unveiled.